NHS Tayside RefGuide
Paediatric nasal obstruction is common. In infants and newborns congenital lesions may contribute to feeding and respiratory complaints, these are usually present immediately after birth and are picked up by neonatologists and paediatricians.In older children, infectious causes, such as sinusitis and allergic rhinitis, are common and are treated medically. If nasal blockage is an acute symptom, consider a foreign body being the cause of it.
It is important to establish presence of other nasal symptoms other than blockage like nasal discharge, bleeding, facial swelling or pain, affected sense of smell, unilateral/bilateral, intermittent/persistent and onset of these symptoms.
Neonatal rhinitis:
- very common, benign, self limiting
- saline drops or suction (neilmed nasal aspirator);
- consider nasal decongestant xylometazoline hydrochloride (otrivine) Child 05% nasal drops (off licence for ≤6 y.o.) for <7 days, if the nasal block is affecting feeding.
Infectious rhinitis:
- antipyretics but no antibiotics unless symptoms persist >10 days
- saline drops/spray/squirt bottle 3x/day
- xylometazoline hydrochloride (otrivine) Child 05% nasal drops (off licence for ≤6 y.o.) for <7 days, if the nasal block is affecting feeding.
Allergic rhinitis:
- avoid allergens if possible
- rinse nose with saline drops/spray/squirt bottle 3x/day
- oral or topical antihistamines (cetirizine ≥2 y.o., loratadine ≥12 y.o.)
- +/- intranasal steroid spray if nasal obstruction is severe (mometasone ≥3 y.o., fluticasone ≥4 y.o., Dymista ≥12 y.o.)
- consider allergen blood tests (grass/tree/weed pollen, house dust mite, pet/farm animal dander)
Foreign body in nose:
- often presents with a smelly unilateral nasal discharge rather than nasal block
- instruct a parent/trusted adult to perform ‘mother’s kiss’
- if button battery suspected refer immediately to ENT on-call
Rhinitis medicamentosa:
- history of frequent/prolonged use of nasal decongestant
- stop or taper nasal decongestant and start nasal steroid spray/drops